Jan. 19, 2010 -- After more than 20 years and nearly $200,000 worth of failed infertility treatments, Monique and Neil Ward of Stafford, England, have finally became the proud parents of twin boys, Britain's Press Association reports.
The Wards' 25-year struggle to become pregnant -- even though ultimately it was through the use of donor sperm and donor eggs -- raises a question many infertility specialists and aspiring parents face: Does there come a point when a couple should give up on trying to conceive?
After 15 failed attempts with various types of assisted reproductive technology since 1986, some might say the Wards were operating on blind optimism when they signed up for another $20,000 round of in vitro fertilization (IVF) with donor eggs and sperm last spring. An earlier round with this technique had failed five months before.
But against all odds, Monique Ward finally became pregnant. On Dec. 29, at the age of 46, she gave birth to two healthy twin boys, Walker and Benjamin.
"When I held them for the first time my eyes just filled up with tears," Mrs. Ward, a nurse, told London's Telegraph. "[I] am still pinching myself that after so long trying it finally happened."
In IVF, egg and sperm (whether from the couple or from donors) are collected and combined in a laboratory dish. Once the egg is fertilized successfully, the growing embryo is transferred to the mother-to-be's uterus where it -- hopefully -- will implant and begin to grow normally.
"What this story shows is that even if you've had lots of failed attempts with more conventional treatment, an older patient can still use donor egg and conceive successfully -- sometimes you're just going to need that high tech treatment," said Dr. Richard Paulson, chief of the division of reproductive endocrinology at the University of Southern California.
The Odds of Conception
The Wards' case is certainly the extreme, but it can take many years of IVF for some couples to conceive, fertility experts say, especially if the couple is trying to conceive without the aid of donor eggs.
Dr. Sherman Silber, director of the Infertility Center of St. Louis at St. Luke's Hospital, shared one example from a colleague in which an Israeli woman went through 31 cycles of IVF before finally becoming pregnant.
In the U.S., due to the high cost of IVF, women are often advised to consider using donor eggs after several failed rounds of IVF given that the odds of conceiving with donor eggs is so much higher.
"It would be extremely unusual for a donor egg not to work" within a few tries," Silber said, "unless there is a uterine problem," which usually would have been identified early on in infertility counseling.
"Most of the time the sperm is not a problem," said Paulson. He said it is more common for the woman to have trouble producing viable embryos.
For the Wards, the quality of the sperm was also an issue because Mr. Ward had had a vasectomy earlier in life which had to be reversed. Such procedures produce working sperm only 50 percent of the time, said Paulson, so ultimately the couple needed to use donor sperm as well as donor eggs.
When you use donor eggs, "you tend to have a 50-50 chance of conceiving," Paulson said, so once Mrs. Ward started using donor eggs, "she flipped the coin in November and it came up tails but in April she flipped again and it came up heads and she had twins."
Though the odds of conception increase greatly with the use of donor eggs, fertility specialists say women are often very reluctant to give up on the dream of having a child that shares their DNA.
"We deal with 40- and 42-year-old women all the time who absolutely don't want donor eggs, but the chance is approximately two percent at age 47 of a woman conceiving a child with her own egg," said Silber.
25 Years Trying to Have a Baby
When a couple realizes that they will have to have another woman be the biological mother of their child, and pay thousands and thousands of dollars to do it, "the response might be, 'Well, gee, shouldn't they just have adopted ?'" said Dr. Ellen Clayton, an ethicist and professor of genetics, health policy, pediatrics and law at Vanderbilt University.
"For many people [adoption] is a wonderful choice," she said, but wanting to carry the child yourself is also "a choice that they ought to be able to make."
"There is something really special about being pregnant," she said, "something primal."
"It's very different from adopting," Paulson agreed. "Everyone would rather have a baby from their own egg and their husband's sperm, but if that's not possible, the next best thing after that is that you get pregnant with donor egg."
"With adoption you get to be a parent once the baby is born but with donor egg, you get to be a parent from the moment of conception," he added.
The mother bonds with the child by carrying it for nine months, said Silber, "and whatever question marks she may have had by it not having her DNA are erased by this bonding process."
For this reason, he said he has never seen a couple using donor eggs have problems feeling that the child "was not theirs" once it was born.
Quitting Time for IVF?
Pregnancy holds great emotional significance for many couples. But when fertility treatments fail time after time, is there ever a point when couples should be advised to stop trying?
It's a tough and very personal question, fertility experts say.
"It all depends on the persistence and philosophy and desire of the couple," said Silber.
"It is so hard to be absolutely definitive in telling someone to quit," he said, but sometimes the emotional and financial stress of repeated failed attempts can take their toll on couples and dogged persistence is not always the best option.
Ultimately, age can become a factor as well, says Clayton.
One of the recurring ethical issues with IVF is whether it is fair to the children, she says, to have much older parents, considering that a 46-year-old new mother may not live to see her child graduate college or to see her grandkids.
But "a life with a 46-year-old mom that really wants you is better than not living at all or being an unwanted child," she said. "We need to resist the temptation to demonize [older mothers using IVF] because of their age and their desire to have the sensation of gestation."
And if they're willing to "move with the technology" and use donor eggs if needed, Paulson says, it shouldn't take a quarter of a century as it did for the Wards.
"I really feel that in today's day and age, almost everyone can become pregnant."
Though Monique Ward may have not have had to wait 25 years if she had used donor eggs earlier, Paulson says the take home message of their story for couples struggling with fertility issues is that "even after trying for 25 years, [she] still got pregnant, so there's hope...you can do it, it can work for you."
"God bless 'em," Dr. Clayton said. "After all this time, now they have kids."